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Jerome L. Fleg, MD; Edward P. Shapiro, MD; Frances O'Connor, MPH; Jean Taube; Andrew P. Goldberg, MD; Edward G. Lakatta, MD

JAMA. 1995;273(17):1371-1375.

Abstract
Objective.
—To determine whether older men who have undergone intensive endurance training over many years demonstrate less age-associated impairment of early diastolic left ventricular (LV) filling performance than their sedentary peers.

Design.
—Cross-sectional prospective study.

Setting.
—Community-dwelling research volunteers.

Participants.
—Sixteen older competitive male endurance athletes aged 52 through 76 years and 17 young (<40 years) and 23 older (52 through 76 years) sedentary control subjects from the Baltimore Longitudinal Study of Aging.

Intervention.
—All subjects underwent resting Doppler echocardiography and determination of maximal aerobic capacity (o₂max) during graded treadmill exercise. Doppler echocardiographic studies were interpreted without knowledge of the subject's age or exercise habits.

Main Outcome Measures.
—Doppler-derived measures of LV diastolic filling performance: peak early (E) filling velocity, peak late (A) filling velocity, ratio of peak E to peak A velocities (E/A), and atrial filling fraction.

Results.
—Older athletes demonstrated higher o₂max (47±6 mL/kg per minute [mean±SD]) than either the young controls (41±7 mL/kg per minute) or older controls (30±7 mL/kg per minute) (P<.05) as evidence of their superior conditioning status. However, peak E diastolic LV filling velocity was higher in young controls (79±17 cm/s) than in older athletes (56±15 cm/s) or older controls (68±18 cm/s) (P<.001). This age difference persisted after normalizing peak E velocity for mitral stroke volume. Peak E/A ratio and atrial filling fraction were also similar in older athletes (1.2±0.5 and 0.41±0.1, respectively) and older controls (1.1 ±0.4 and 0.41 ±0.1, respectively), and differed significantly from corresponding values of 1.7±0.4 and 0.33±0.1 in young controls (P<.001 and P<.05, respectively). By multiple regression analysis, age but not treadmill o₂max was a significant predictor of peak E velocity, peak A velocity, peak E/A ratio, and atrial filling fraction.

Conclusion.
—Older men with a long history of intensive endurance training demonstrate impaired early diastolic LV filling similar to that of their sedentary peers. Thus, impairment of early diastolic filling appears to be intrinsic to normative aging and not secondary to the reduction in aerobic capacity that accompanies the aging process.

(JAMA. 1995;273:1371-1375)

Author Affiliations
From the Laboratory of Cardiovascular Science, Gerontology Research Center, National Institute on Aging (Drs Fleg and Lakatta and Ms O'Connor); Cardiology Division, Johns Hopkins Bayview Medical Center (Dr Shapiro and Ms Taube); and Division of Gerontology, University of Maryland, School of Medicine (Dr Goldberg), Baltimore, Md.

Footnotes
Reprint requests to Laboratory of Cardiovascular Science, Gerontology Research Center, 4940 Eastern Ave, Baltimore, MD 21224 (Dr Fleg).

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